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Monthly Archives: February 2012

Pyeloplasty surgery is performed to repair a narrowing or stricture at the junction between the kidney and the ureter known as the uretero-pelvic junction or UPJ. A crossing vessel or stricture at the UPJ causes progressive dilatation of the renal pelvis subsequently leading to swelling (hydronephrosis) and worsening renal function or renal failure.

Miami urologist, David Robbins MD is a board certified urologist and recognized leader in da Vinci robotic surgery and expert in robotic pyeloplasty surgery for both stricture disease and crossing vessel at the UPJ (UPJ obstruction). Dr. Robbins trained at New York University and learned to perform robotic pyeloplasty procedures from Dr. Michael Stifelman, internationally acclaimed leader in the field of robotic surgery for the kidney and ureter.

Pyeloplasty procedures using the robotic approach are a minimally invasive option for pyeloplasty performed though four keyhole sized incisions as opposed to a long painful flank incision traditionally used for this surgery. Robotic pyeloplasty procedures are associated with decreased blood loss, less pain and a shorter hospital stay. Miami urologist David Robbins, MD is currently performing robotic pyeloplasty surgery at Mount Sinai Medical Center in Miami Beach as well as Aventura Hospital and Medical Center in Aventura.

“Low testosterone and male andropause has become a hot topic over the past decade. Aging men with symptoms of low sex drive, decreased energy and muscle mass as well as erectile dysfunction are seeking a remedy for their complaints. These symptoms may be secondary to low testosterone. In addition to the symptoms of decreased energy and libido associated with low testosterone, patients may also be at risk for osteoporosis, decreased muscle mass, impaired cognitive ability and concentration, decreased exercise tolerance and even metabolic syndrome and impaired heart health. If you are experiencing any of the above symptoms, please contact us or your current urologist to have your testosterone levels evaluated. Miami urologists David Robbins, MD and Amery Wirtshafter, MD are board certified urologist specializing in the evaluation and treatment of male hypogonadism or testosterone deficiency.

(MayoClinic.com) Hormone changes are a natural part of aging. Unlike the more dramatic reproductive hormone plunge that occurs in women during menopause, however, sex hormone changes in men occur gradually — over a period of many years. Here’s what to expect, and what you can do about it.

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The term “male menopause” is sometimes used to describe decreasing testosterone levels or a reduction in the bioavailability of testosterone related to aging. Female menopause and so-called male menopause are two different situations, however. In women, ovulation ends and hormone production plummets during a relatively short period of time. In men, hormone production and testosterone bioavailability decline more gradually. The effects — such as changes in sexual function, energy level or mood — tend to be subtle and might go unnoticed for years.

So what’s the best way to refer to so-called male menopause? Many doctors use the term “andropause” to describe aging-related hormone changes in men. Other terms for so-called male menopause include testosterone deficiency, androgen deficiency of the aging male and late-onset hypogonadism.

Understanding male hormones over time

Testosterone levels vary greatly among men. In general, however, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average. By about age 70, the decrease in a man’s testosterone level can be as much as 50 percent.

Recognizing low testosterone levels

Some men have a lower than normal testosterone level without signs or symptoms. For others, low testosterone might cause:

Emotional changes. Low testosterone might contribute to a decrease in motivation or self-confidence. You might feel sad or depressed, or have trouble concentrating or remembering things.

It’s important to note that some of these signs and symptoms are a normal part of aging. Others can be caused by various underlying factors, including medication side effects, thyroid problems, depression and excessive alcohol use. A blood test is the only way to diagnose a low testosterone level or a reduction in the bioavailability of testosterone.

Feeling your best

If you suspect that you have a low testosterone level, consult your doctor. He or she can evaluate possible causes for your signs and symptoms and explain treatment options. You can’t boost your natural testosterone production, but these steps might help:

Be honest with your doctor.Work with your doctor to identify and treat any health issues that might be causing or contributing to your signs and symptoms — from medication side effects to erectile dysfunction and other sexual issues.

Seek help if you feel down.Depression in men doesn’t always mean having the blues. You might have depression if you feel irritable, isolated and withdrawn. Other signs of depression common in men include working excessively, drinking too much alcohol, using illicit drugs or seeking thrills from risky activities.

Be wary of herbal supplements. Herbal supplements haven’t been proved safe and effective for aging-related low testosterone. Some supplements might even be dangerous. Long-term use of DHEA, for example, has no proven benefits and might increase the risk of prostate cancer.

Treating aging-related low testosterone with testosterone replacement therapy is controversial. For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency. For others, however — particularly older men — the benefits aren’t clear. The risks are a concern as well. Testosterone replacement therapy might increase the risk of prostate cancer or other health problems. If you wonder whether testosterone injections or other testosterone treatments might be right for you, work with your doctor to weigh the pros and cons.

“Nerve Sparing Radical Prostatectomy in addition to providing the benefit of improved post operative erectile function for men with localized prostate cancer may improve the ability to achieve normal orgasm. Miami urologist, David Robbins, MD is a regional expert in robotic assisted radical prostatectomy using the da Vinci surgical robot and offers patients the opportunity to have their prostate cancer treated with minimal effect on their quality of life with regard to measures such as erectile function and maintenance of continence. This article shows evidence that nerve sparing prostatectomy may additionally result in improved ability to achieve normal orgasms.” Miami urologist, David Robbins MD

Nerve-Sparing Prostate Surgery Helps Men Retain Sexual Function

Most men left with nerves on both sides of the gland can achieve orgasm, study shows

THURSDAY, Feb. 16 (HealthDay News) — Most men who have surgery for prostate cancer can still achieve orgasm if the nerves that surround their prostate gland are not removed, according to a new study.

Researchers from Cornell University say a man’s age and the number of his nerves that are spared will play a role in his ability to climax after surgery.

The study followed 408 men who underwent a procedure to remove their prostate, known as robot-assisted laparoscopic radical prostatectomy, between 2005 and 2007 for an average of three years. Men had mean age of 60 years and all were able to have an orgasm before the procedure.

Seventy-four percent of the men were able to have their nerves spared bilaterally, or on both sides. Of those men, 91 percent experienced no change in their ability to achieve orgasm following the surgery.

About 13 percent of the men had their nerves spared on only one side. Of this group, 82 percent of the men had the same ability to reach orgasm. Another 12 percent had little or no nerve sparing, with 62 percent of them were still able to achieve orgasm the same way they did before the operation.

The men’s age also played a role in their ability to orgasm. The study, published in the February issue of BJUI, showed orgasm rates were significantly higher in men younger than 60 who had their nerves spared on both sides. Orgasm rates dropped by 10 percent to 83 percent among men older than 60, even if their nerves were spared on both sides.

A questionnaire completed by 156 of the men who were able to achieve orgasm after surgery revealed 82 percent had high satisfaction rates. Another 10 percent said they had moderate satisfaction and 7 percent reported low satisfaction. Roughly 3 percent of the men said they experienced a painful orgasm.

“As far as we are aware, this is the largest analysis of orgasmic function in the robotic prostatectomy literature and will provide valuable information for surgeons talking to patients about what sort of sexual function they can expect after surgery,” study author Dr. Ashutosh Tewari, director of the Prostate Cancer Institute and the LeFrak Robotic Surgery Center at Weill Cornell Medical College, said in a journal news release.

More information

The U.S. National Institutes of Health provides more information on prostate cancer.

Some urologists around the country are reporting increased numbers of patients coming in for vasectomies.

The schedule for Jones, a Cleveland, Ohio, urologist, has become more crowded during a recent boom in vasectomies.

“My staff came to me and said, what’s happening?” said Jones, the chairman of the Department of Regional Urology of Glickman Urological and Kidney Institute at the Cleveland Clinic. “Why are we suddenly having an explosion in guys asking for vasectomies?”

They looked at their statistics and realized the uptick started around November as the economic crisis deepened. October went down in the history books as one of Wall Street’s worst months.

Since then, the Cleveland Clinic has seen a 50 percent increase in vasectomies, an outpatient surgery that is the cheapest form of permanent birth control. Vasectomies are less invasive and cheaper than tubal ligation, which involves blocking, tying or cutting a woman’s fallopian tubes to prevent pregnancy.

“It’s unlikely that some guy read the Dow Jones numbers that day and said, ‘Why don’t we have a vasectomy?’ ” Jones said. “More likely, people have already been considering it and typically a guy and his wife have spoken a year or two about this.”

Jones was told by patients that they were getting vasectomies because they were losing their jobs and health insurance, or concerned about being out of work soon

“They realize they don’t have the financial security long-term with what’s going on,” Jones said. “Several of them have mentioned, ‘We can’t afford to have any more children in this economy.’ My perception is that it’s more of the concept of raising children in an uncertain economic future.”

Much like Jones, Dr. Marc Goldstein, surgeon-in-chief of male reproductive medicine and surgery at the Cornell Institute for Reproductive Medicine in New York, saw a 48 percent increase in vasectomy consultations compared with the same time last year.

“I have never seen anything like this,” said Goldstein, a urologist for the last 30 years. “When things started to go south in the stock market, then the vasectomy consults went north.”

Half of Goldstein’s New York patients work in the financial sector. New patients filed into his office in November.

“I think the situation of finance and the economy is the major reason,” Goldstein said. “Some of them have mentioned that, ‘It cost $30,000 a year to put my kids in private school and I can’t afford to have another one.’ It’s never the sole reason, but it’s certainly a contributing factor.”

During the vasectomy, the doctor cuts the two vas deferens, which are the tubes carrying sperm from the testicles to become semen. After the procedure, men can still have sex, but their semen does not contain sperm and therefore they can no longer father children.

Doctors can attempt to reverse the procedure, but vasectomy reversals are expensive and only work half the time in restoring sperm flow.

“Some folks will postpone having kids,” he said. “If you had a vasectomy, you’ve made a bigger decision that you’re never going to have another child.”

When people stop having children, it implies a loss of confidence in their future employment prospects.

“Am I going to have a job in six months or a year from now?” Haub said. “If I’m concerned about that, people are not going to increase their financial obligations… It’s naïve to say the economy didn’t play a significant role in lowering the birth rate.”

It’s too early to tell whether this recession has crimped the birth rate, Haub said.

At this point, most of the evidence of increased vasectomies has been anecdotal from practicing urologists, because there is no national registry for sterilizations.

The number of appointment requests spiked 30 percent in January 2009 on the Web site vasectomy.com, which links people with local urologists. But throughout the last few months, appointment requests have been fairly level, said Dr. Ted Benderev, founder of the site.

Dr. Lawrence Ross, a professor of urology at the University of Illinois at Chicago and former president of the American Urological Association, said the school’s clinics have seen moderate increases in the last six months to a year and that vasectomies are growing popular among lower-income clients.

“My guess is that since economic times have worsened, people are concerned about their ability to raise larger families and are opting for more permanent birth control,” Ross said.

People who are concerned about losing their health insurance are trying to take advantage of the coverage for a procedure they’ve long considered.

“It may have something to do with the economy,” said Dr. Bryan Kansas, a urologist. “I can’t count on my hands, in the last three months, the number of times someone has said they’re about to lose their insurance and ask to squeeze them in.”

He and his colleagues have seen a similar uptick in their Austin, Texas, practice called The Urology Team.

Throughout March Madness, Kansas’ office has a special on vasectomies called, “Vas-Madness” to capitalize on their patient’s obsession with the college basketball tournament.

Patients “would love to have a procedure, go home and sit there when you’ve got all-day programming, watch basketball,” Kansas said.

After the lessthan-hourlong procedure, patients usually spend a day or two recovering, moving gingerly and icing the soreness. Some men time their vasectomies around the time of major sports events such as the Masters Golf Tournament and the NCAA basketball tournament to keep themselves entertained during recovery.

Vasectomies are likely to produce tenderness, discomfort and slight swelling and the patient is usually able to return to usual activities within a week.